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The past 20 years have witnessed a change in the management control system in Italian National Health Service to align with New Public Management (NPM) principles. Performance measurement and the management of public entities constitute the main pillars of the NPM, particularly in terms of output production, efficiency and parsimony, which helps integrate performance information in the management decision. In turn, healthcare organizations have begun implementing performance management systems (PMSs) as well as new tools, such as the balanced scorecard (BSC). In this study, we analyze the newly implemented PMS in the Verona Integrated University Hospital (VIUH). This organization was formed through the merger between the teaching hospital and the independent hospital of Verona. In particular, the main features of VIUH’s PMS are fourfold: activity, resources, professional quality and perceived quality. To understand the goals of VIUH’s PMS and the factors that enable or hamper its adoption, we conduct a qualitative analysis on several semi-structured interviews. The study reveals that the introduction and implementation of the PMS in VIUH came about mainly as a result of the hierarchical control of the regional government and, in striving to uphold professional quality indicators, as a response to clinicians’ resistance to change.